The NHS Continuing Healthcare process

The process surrounding CHC funding is set out in The National Framework for NHS Continuing Healthcare Assessments and NHS-Funded Nursing Care by the Department of Health and Social Care. In this guide, we break down the stages of an NHS care funding application in simple terms, helping you understand the process.

There are three key stages to the CHC process – the checklist, the assessment and the outcome. Below, we detail each of these stages.

Stage 1 – Continuing Healthcare Checklist

A CHC checklist is the first stage in determining whether an individual is eligible for free care, and can be considered a lighter check, before a full assessment. Here is an example of a checklist for NHS Continuing Healthcare.

This checklist will help care professionals understand eligibility for a full assessment and whether a person might have a potential need. It will be completed by a trained health or social care professional.

The assessor will consider the individual’s needs across 11 care domains, scoring them on a scale of high-level (A), moderate-level (B), or low/no needs (C).

Learn more: What are the care domains for CHC?

A person will qualify for a full assessment and move to stage two if:

• They have two or more high-level needs.
• They have one high-level need in a critical domain.
• They have five or more moderate-level needs.
• They have one high-level need and four or more moderate-level needs.

Please note: This assessment should not be undertaken when a person is in an acute hospital setting, and should only take place once they’ve been discharged to a nursing home or to health and social care. If the patient is already in a nursing home, or chooses to remain in their own home, then the responsibility for conducting this assessment lies with the Integrated Care Board.

Stage 2 – Decision Support Tool Assessment

For stage two of the CHC funding process, a multidisciplinary team (MDT) will conduct an assessment using the Decision Support Tool.

The multidisciplinary team is a group of professionals from different fields, often comprising nurses, social workers, GPs, therapists, other specialists and the individual and their family members. This team gives a holistic view of a person’s health, social and emotional needs, looking further than simply medical issues.

Using the Decision Support Tool, the MDT will assess the individual against 12 care domains, scoring them on a scale of No Needs (N) to Priority Needs (P). The score given will reflect the nature, intensity, complexity and unpredictability of the need, with a greater risk or impact resulting in a higher score. You can see an example of a Decision Support Tool document here.

This process determines whether an individual has a primary health need, making them eligible for NHS Continuing Healthcare funding.

Stage 3 – Outcome

The multidisciplinary team will then recommend to the Integrated Care Board whether the individual is eligible for CHC. There are two possible recommendations they will make:

• An individual is eligible for CHC – when this recommendation is made, the NHS becomes responsible for planning, sourcing and funding the package of support based on the care needs identified
• An individual is not eligible for CHC – when this recommendation is made, NHS funding is not available. However, the decision can be reviewed by the Integrated Care Board through an appeal.

If you do not agree with the decision reached during the full assessment, then the decision can be appealed. An appeal has to be backed by evidence that demonstrates the decision reached was flawed.

Learn more: How do I appeal a CHC funding decision?

We have expert knowledge and experience in the appeals process, and can advise on whether you have a basis for an appeal and assist you in the full appeals process. We have a strong success rate of securing funding after attending panel hearings and advocating for our clients.

The NHS Continuing Healthcare assessment process should be completed within 28 days from the date of referral.

If the process takes longer than this and the individual being assessed is found to be eligible for CHC funding, the NHS has a responsibility to cover the care fees incurred due to the delay.

Yes, in the instance that an individual is approaching the end of their life, a fast-track assessment can be initiated to help them  receive prompt funding to meet the cost of their care.

Learn more: What is a CHC Fast-Track Assessment?

A fast-track assessment can usually be completed within 48 hours (as opposed to the usual 28 days), ensuring a care and support package can be put into place as soon as possible.

This can be completed by a clinician, GP or registered nurse with knowledge and experience of an individual’s health needs on behalf of the patient.

Having an expert on your side matters. We have spent over a decade working with individuals and families, helping them navigate the process and receive the funding they deserve. From gathering evidence to ensuring the correct scoring is awarded during the assessment process, we will work tirelessly to secure the best outcome for you. And, with our fixed fee approach, you’ll know the cost upfront.

Whether you are at the start of your funding process, struggling with a CHC assessment or in need of support for an appeal, start a free, no-obligation enquiry today to see how we can help.